Comparison of Outcome in Women with Non-Reactive Cardiotocography versus Non-Reactive Cardiotocography and Fetal Scalp Blood Sampling

Abstract

Background: Intrapartum assessment of the fetus is a challenging task. And a good fetal surveillance during labour often entails monitoring the fetal heart rate with cardiotocography (CTG). The fetal heart rate pattern is an indicator of medullary response of fetal brain to the acidemia, blood volume changes and hypoxemia, as the brain modulates the fetal heart rate. But specificity of CTG is low that’s why generally intrapartum cardiotocography is combined with a second variable, such as Fetal Scalp Blood sampling, to improve its specificity. The increased intervention rates associated with non-reactive cardiotocography can be reduced with the use of fetal scalp blood sampling. Objectives: To compare frequency of caesarean section with use of non- reactive Cardiotocography versus non-reactive Cardiotocography and fetal scalp blood sampling. To determine the immediate neonatal outcome in terms of death, Apgar score and need for intensive care unit admission after delivery. Study Design: This study was cross sectional analytical study. Settings:  Obstetrics and Gynaecology department, Unit-I, Lady Willingdon Hospital, Lahore, affiliated with King Edward Medical University. Duration:  The duration of study was 1 year. Methodology: The non-probablity purposive sampling technique was used in this study. 100 patients in labour at term presented to labour room of Lady Willingdon Hospital, and fulfilling the inclusion criteria were enrolled in this study. After taking informed written consent, the patients were divided into two groups (A and B). In group A, 50 cases having non-reactive Cardiotocography were taken and according to fetal assessment by Cardiotocography all were taken for caesarean section. In group B, 50 cases having non-reactive Cardiotocography were taken and fetal assessment was done by continuous Cardiotocography as well as fetal scalp blood sampling. In group B, fetal hypoxia was assessed by fetal blood pH. Only those cases in group B underwent caesarean section, where fetal hypoxia was confirmed by fetal blood pH (pH=<7.20). Apgar score at 1 min and 5 min and admission to neonatal intensive care unit (NICU) was noted for postnatal fetal assessment in both the groups. Data was entered and analyzed through SPSS version 21. To calculate sensitivity, specificity, Positive predictive value (PPV), negative predictive value (NPV) and fetal scalp blood pH 2x2 tables were generated, taking pH as gold standard. Results: In this study among 100 patients, the mean age of the patients was noted as 27.64±4.38 years and the mean gestational age was noted as 39.30±1.05 weeks. The mean Apgar score at 1 minute of the baby was noted as 5.62±1.39, whereas at 5 minutes was noted as 6.76±2.09. In group B among 50 cases the mean pH value of fetal scalp blood was noted as 7.25±0.048. Fetal scalp blood sampling was normal in 20/50 (40%) patients, borderline in 24/50 (48%) patients, whereas it was abnormal in 6/50 (12%) patients. In group A, among 50 cases all underwent lower segment Caesarean section (LSCS).  In group B, among 50 cases, 30/50 (60%) cases underwent LSCS while 20/50 (40%) underwent spontaneous vaginal delivery. In group A, 28/50 (56%) cases had Apgar <7 at 5 minutes while in group B, 18/50 (36%) cases had Apgar <7 at 5 minutes. In group A, 4/50 (8%) cases died while in group B, no mortality was observed. There was significant difference observed between group A and cases in group B for all these factors. In group A, 10/50 (20%) cases had NICU admission while in group B, only 6/50(12%) cases had NICU admission. There was no significant difference observed between two groups in NICU admission. Conclusion: It was concluded that CTG coupled with fetal blood sampling for fetal pH versus carditocography alone is an accurate method for assessment of fetal condition in labour to decide the mode of delivery and neonatal outcome after birth.